This is part of a series on the five ambulatory surgery center specialties to watch in 2012. The five specialties are gynecology, ophthalmology, orthopedics and spine, pain management and urology. These specialties have a favorable outlook in terms of case volume, revenue and new procedures moving into the ASC setting.
As the population ages, the demand for ophthalmic procedures, such as cataract and vitreoretinal surgery, will increase. For a volume-driven specialty like ophthalmology, this demand can mean increased profits and a better ability to weather decreasing reimbursements. Currently, ophthalmology cases average profits of $100-200 in surgery centers.
Larry E. Patterson, MD, medical director of Eye Centers of Tennessee and the Cataract and Laser Center, Crossville, Tenn., and past president of the Outpatient Ophthalmic Surgery Society, addresses five points on ophthalmology in 2012 and beyond.
1. Retina surgery will take off. In 2008, the new Medicare reimbursement guidelines started implementing a payment system that increased the reimbursements for certain procedures in ASCs, including retina surgery, over a four year period. This year marks the end of that period, and retina surgery is now fully covered in the ASC setting, says Dr. Patterson.
"There were people doing retina in surgery centers, but they were hardly getting paid enough to break even," he says. "They just hated to work in hospital. Now you can actually do it profitably."
However, the upfront cost of the equipment is expensive, so surgery centers looking to add the procedure should ensure a case volume high enough to guarantee profitability.
2. Demand for cataract surgery is increasing. An Ophthalmic Market Perspectives report estimated the volume of cataracts grew from 2.4 million in 2000 to 3.2 million in 2010. Cataracts affect more than 22 million people in the United States, and cataract surgery is the most effective procedure to treat the condition. With baby boomers aging, that number will only continue to increase as incidence increases with age. A recent UPI report found that half of the U.S. population has cataracts by age 65. Dr. Patterson said 60 percent of cataract surgeries are currently performed in ASCs. He has already seen an increase in his cataract surgery volume.
"My cataract surgery volume is significantly up compared to the last few years," he says. "There are just more older people who are getting cataracts. This current generation is a little more aggressive. They are not as tolerant of visual loss. They want their cataracts out earlier."
At OSN New York last month, Reay H. Brown, MD, said cataract surgery is gaining popularity as a treatment for glaucoma because it is less risky than glaucoma surgery. He said the procedure is especially well-suited for open-angle glaucoma and angle-closure glaucoma. According to the American Academy of Ophthalmology, glaucoma affects about 2.3 million Americans over the age of 40. As with cataracts, the incidence rises as people age.
3. New technology and implants will improve care and increase case volume. Dr. Patterson said much of the growth in volume is attributable to new technology such as premium intraocular lenses and the femtosecond laser.
Premium implants include implantable collamer lenses for myopia as well as multifocal and accommodative lenses, and toric implants, which correct for astigmatism. Currently, multifocal and accommodative implants allow patients to see both near and far, but do not work well for patients with significant astigmatism. Ophthalmologists can treat astigmatism with limbal relaxing incisionss, where small incisions are made at the edge of the cornea. Dr. Patterson says in the future, both components can be achieved with one premium implant.
While the femtosecond laser, which uses ultrashort pulses, represents a great future opportunity, it is not yet an economically feasible option for ASCs.
"The problem right now is there no reimbursement, and it's expensive," he says. "To me, it's something that needs to be watched and investigated. It will be a few years down the road."
4. The battle over optometrist scope of practice will continue. Earlier this year, Kentucky passed the "Better Access to Quality Eye Care Act" that expanded the scope of practice for optometrists to include certain surgical procedures. The use of laser technology has in some ways made surgical procedures easier, but the misconception that they are simple or minor surgeries is wrong, Dr. Patterson says.
"It's only minor as long as there are no complications," he says.
He calls the law "an embarrassing mark on Kentucky" and is afraid that it's going to be a continued issue.
"Because of that success, there are going to be attempts all over the country," he says. "I don't think they'll be quite as successful elsewhere."
Dr. Patterson's practice employs two ophthalmologists and five optometrists, and they have discovered they can "argue all day" about where the scope of practices should stop.
"The thing is that every ophthalmologist will draw his line in the sand at surgery," he says.
5. There has been success with lobbying efforts. On behalf of OOSS, Dr. Patterson went to Washington, D.C., to speak to legislators about the requirement that patients have one day to read and understand the consent form before undergoing a YAG laser capsulotomy procedure to open cloudy posterior capsules after cataract surgery.
He says the procedure is simple enough that it's a waste of both the patient's and the surgeon's time to have to wait a day when patients can start seeing better the same day. He says this is one example of government over-stepping its bounds and passing legislations with "good intentions but bad outcomes."
Despite the success in this one case, Dr. Patterson says most of the challenges facing ophthalmology are related to the government reducing reimbursements and increasing regulation.
"In ophthalmology, about 90 percent of our patients are Medicare," he says. "We have two dueling problems. Government is increasing the regulatory burden but not increasing the reimbursement, and sometimes they're decreasing it."
More Expertise from Dr. Patterson:
10 Top Concerns for Surgery Center Physicians in 2012
Ophthalmology in ASCs: Current Trends and Issues
Technological Changes Affecting Eye ASCs: Q&A With Larry Patterson of Eye Centers of Tennessee
As the population ages, the demand for ophthalmic procedures, such as cataract and vitreoretinal surgery, will increase. For a volume-driven specialty like ophthalmology, this demand can mean increased profits and a better ability to weather decreasing reimbursements. Currently, ophthalmology cases average profits of $100-200 in surgery centers.
Larry E. Patterson, MD, medical director of Eye Centers of Tennessee and the Cataract and Laser Center, Crossville, Tenn., and past president of the Outpatient Ophthalmic Surgery Society, addresses five points on ophthalmology in 2012 and beyond.
1. Retina surgery will take off. In 2008, the new Medicare reimbursement guidelines started implementing a payment system that increased the reimbursements for certain procedures in ASCs, including retina surgery, over a four year period. This year marks the end of that period, and retina surgery is now fully covered in the ASC setting, says Dr. Patterson.
"There were people doing retina in surgery centers, but they were hardly getting paid enough to break even," he says. "They just hated to work in hospital. Now you can actually do it profitably."
However, the upfront cost of the equipment is expensive, so surgery centers looking to add the procedure should ensure a case volume high enough to guarantee profitability.
2. Demand for cataract surgery is increasing. An Ophthalmic Market Perspectives report estimated the volume of cataracts grew from 2.4 million in 2000 to 3.2 million in 2010. Cataracts affect more than 22 million people in the United States, and cataract surgery is the most effective procedure to treat the condition. With baby boomers aging, that number will only continue to increase as incidence increases with age. A recent UPI report found that half of the U.S. population has cataracts by age 65. Dr. Patterson said 60 percent of cataract surgeries are currently performed in ASCs. He has already seen an increase in his cataract surgery volume.
"My cataract surgery volume is significantly up compared to the last few years," he says. "There are just more older people who are getting cataracts. This current generation is a little more aggressive. They are not as tolerant of visual loss. They want their cataracts out earlier."
At OSN New York last month, Reay H. Brown, MD, said cataract surgery is gaining popularity as a treatment for glaucoma because it is less risky than glaucoma surgery. He said the procedure is especially well-suited for open-angle glaucoma and angle-closure glaucoma. According to the American Academy of Ophthalmology, glaucoma affects about 2.3 million Americans over the age of 40. As with cataracts, the incidence rises as people age.
3. New technology and implants will improve care and increase case volume. Dr. Patterson said much of the growth in volume is attributable to new technology such as premium intraocular lenses and the femtosecond laser.
Premium implants include implantable collamer lenses for myopia as well as multifocal and accommodative lenses, and toric implants, which correct for astigmatism. Currently, multifocal and accommodative implants allow patients to see both near and far, but do not work well for patients with significant astigmatism. Ophthalmologists can treat astigmatism with limbal relaxing incisionss, where small incisions are made at the edge of the cornea. Dr. Patterson says in the future, both components can be achieved with one premium implant.
While the femtosecond laser, which uses ultrashort pulses, represents a great future opportunity, it is not yet an economically feasible option for ASCs.
"The problem right now is there no reimbursement, and it's expensive," he says. "To me, it's something that needs to be watched and investigated. It will be a few years down the road."
4. The battle over optometrist scope of practice will continue. Earlier this year, Kentucky passed the "Better Access to Quality Eye Care Act" that expanded the scope of practice for optometrists to include certain surgical procedures. The use of laser technology has in some ways made surgical procedures easier, but the misconception that they are simple or minor surgeries is wrong, Dr. Patterson says.
"It's only minor as long as there are no complications," he says.
He calls the law "an embarrassing mark on Kentucky" and is afraid that it's going to be a continued issue.
"Because of that success, there are going to be attempts all over the country," he says. "I don't think they'll be quite as successful elsewhere."
Dr. Patterson's practice employs two ophthalmologists and five optometrists, and they have discovered they can "argue all day" about where the scope of practices should stop.
"The thing is that every ophthalmologist will draw his line in the sand at surgery," he says.
5. There has been success with lobbying efforts. On behalf of OOSS, Dr. Patterson went to Washington, D.C., to speak to legislators about the requirement that patients have one day to read and understand the consent form before undergoing a YAG laser capsulotomy procedure to open cloudy posterior capsules after cataract surgery.
He says the procedure is simple enough that it's a waste of both the patient's and the surgeon's time to have to wait a day when patients can start seeing better the same day. He says this is one example of government over-stepping its bounds and passing legislations with "good intentions but bad outcomes."
Despite the success in this one case, Dr. Patterson says most of the challenges facing ophthalmology are related to the government reducing reimbursements and increasing regulation.
"In ophthalmology, about 90 percent of our patients are Medicare," he says. "We have two dueling problems. Government is increasing the regulatory burden but not increasing the reimbursement, and sometimes they're decreasing it."
More Expertise from Dr. Patterson:
10 Top Concerns for Surgery Center Physicians in 2012
Ophthalmology in ASCs: Current Trends and Issues
Technological Changes Affecting Eye ASCs: Q&A With Larry Patterson of Eye Centers of Tennessee